The Fund for a Healthy Maine is Maine’s portion of the tobacco settlement dollars. It is not taxpayer dollars. We receive these funds because Maine people got sick and died from tobacco use; this is a legacy to be honored.

We have an ethical and moral obligation to allow the fund to work as intended, which is to prevent disease and promote good health so Mainers can be well and productive for generations to come.

about the authors

Steve DiGiovanni, M.D., is medical director of Maine Medical Partners Outpatient Clinics, and Toho Soma, M.P.H., is acting public health director for the city of Portland.

The governor’s budget proposes taking $10 million from the Fund for a Healthy Maine to pay for Medicaid reimbursements to health care providers. One of the reasons given for this reallocation is that disease prevention should happen in the medical provider’s office. This statement is misleading and unfair to both the medical and the public health professions.

Medicine and public health are not synonymous. Take the example of e-cigarettes.

Last year, for the very first time, youths’ e-cigarette use was higher than their use of traditional cigarettes. Additionally, youths’ intention to use traditional cigarettes was twice as high among youth who used e-cigarettes than those who had not.

Considering that tobacco use already costs Maine $811 million per year in direct health care costs, keeping young people from living their lives addicted to tobacco is a priority of both the medical and public health professions.

A medical provider will see a teenager at an annual well visit and will ask him if he currently uses tobacco products.

If the teen says he does, the doctor will have a conversation with him about the dangers of tobacco use, the supports that exist for quitting and the ways to stay tobacco-free. This is an important conversation for the doctor to have with the teen, and we know that people listen to the advice of their doctor when it comes to their health.

This is an early intervention, because we are intervening at the first sign of a problem. It is important and effective, but as a medical provider and public health professional, we can tell you it isn’t enough.

Why? Because while this is an effective intervention for a medical provider’s office, the best scenario is that the teen never begins smoking in the first place.

The best scenario is one where a public health professional is working with retailers to ensure they know that selling e-cigarettes to minors in Maine is illegal.

It is an environment where retailers receive training and support on how to properly card minors, where to display tobacco products to discourage underage smoking and how to comply with relevant state laws.

The best scenario is one that includes public health professionals working with schools to incorporate e-cigarettes into their tobacco policy and health curricula.

This is the role of public health and primary prevention – intervening before the teen is at the doctor’s office and reports that he is already using tobacco. It is these services that are proposed to be cut in the governor’s budget.

Furthermore, services to the Center for Tobacco Independence could also be cut through the governor’s budget, including the Maine Tobacco Helpline. Without this crucial piece of the puzzle that has proven so successful, primary care providers would be even less equipped to provide treatment options for a smoker interested in quitting.

The Center for Tobacco Independence Trainings help physicians to more effectively prevent and treat tobacco use. In addition, the Maine Tobacco Helpline increases a tobacco user’s chances of quitting by 200 percent to 300 percent over trying on his own! No amount of insurance reimbursements could replace this deficit in services.

It is not the responsibility of medical professionals to work with tobacco retailers. It is not the responsibility of public health professionals to participate in well-child visits and provide medical advice to teens about health care interventions. Both are important, both are proven to be effective and both are needed to reach the end goal we all share: to reduce health care costs and ensure that individuals live longer, healthier lives.

To say that we cannot afford both and that we must choose is a false choice. To say that one profession can do the work of the other without recognizing the stark differences in these two fields is dangerous.

It is dangerous because research shows that without a combination of both approaches, health care costs and disease rates could rise. We urge Mainers not to be fooled into believing that we have to make this false and dangerous choice.

Here at MaineToday Media we value our readers and are committed to growing our community by encouraging you to add to the discussion.

To ensure conscientious dialogue we have implemented a strict no-bullying policy. To participate, you must follow our Terms of Use. Click here to flag and report a comment that violates our terms of use.